Provider Demographics
NPI:1346829041
Name:WELLNESS AND PREVENTIVE CARE OF SWFL. LLC
Entity Type:Organization
Organization Name:WELLNESS AND PREVENTIVE CARE OF SWFL. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:MILADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBOLAY IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:941-451-3361
Mailing Address - Street 1:112 ORTONA ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-5334
Mailing Address - Country:US
Mailing Address - Phone:194-145-1336
Mailing Address - Fax:
Practice Address - Street 1:5598 8TH ST W UNIT 4
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-3397
Practice Address - Country:US
Practice Address - Phone:941-451-3361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105654200Medicaid